Several transcranial routes have been described for either pituitary adenomas or other tumors of the sellar region, such as craniopharyngiomas. These are summarized in Fig. 1 and Table 2 (p. 154). These approaches reflect the various directions in which the suprasellar component of these lesions may grow. Apart from the region of the optic chiasm, access may be required to the anterior or the middle fossa and sometimes to the third ventricle or the cavernous sinus.
Although each surgical route has its keen exponents and its specific applications, one must not forget that a combination of approaches may be required, either at one operation or in stages. In general, however, the best results are achieved by becoming familiar with one approach that can safely be applied in the majority of cases. We, therefore, carry out most intracranial operations via the oblique subfrontal route as described in the following subheading and reserve other routes for difficult cases. These are the high craniopharyngiomas and similar lesions that involve the third ventricle, particularly when there is a prefixed chiasm that limits access to the tumor from the subfrontal approach.
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